Impact of the Ventilator-associated Pneumonia Bundle in a Medical Intensive Care Unit

Abstract

Introduction: Ventilator-associated pneumonia(VAP) in the intensive care unit affects the patient mortality and the bundle is used as an intervention to reduce it. Objectives: This study was to investigate the compliance of the VAP bundle and to determine the effect of the bundle on the decrease of VAP rate. Methods: A pretest-posttest experimental study was done. Patients in the medical intensive care unit with a 48-hour ventilator were included. The incidence of VAP was compared between January 2014 and June 2014 before implementation of the bundle and between October 2014 and March 2015 after implementation. There were 112 subjects before application of bundle and 107 subjects after application. VAP bundles included sedative interruption and assessment of readiness to extubate, elevation of the head of the bed 30degree, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, daily oral care with 0.12% chlorhexidine, intra-cuff pressure control, and aspiration of subglottic secretions. Results: After the application of bundles, the compliance of nurses increased from 27.6%(8/29) to 65.5%(19/29) and VAP cases decreased from 3 to 1. The ventilator days were 2,143 days before the intervention and 2,232 days after the intervention. The VAP rate per 1,000 ventilator insertion days was 1.40 before the intervention and decreased to 0.45 after the intervention, but there was no significant difference. Conclusion: There was no statistically significant decrease in VAP incidence, but bundle compliance was increased. However, it is meaningful that we conducted a study on bundle compliance in Korea. It is recommended that a bundle suitable for the Korean situation be developed.